eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey.

BACKGROUND: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.

Relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer.

Introduction: Bladder cancer is one of the most important diseases that threatens oral and dental health due to its nature and side effects of chemotherapy. Therefore, the present study was conducted to investigate the relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer. Methods: This cross-sectional study was conducted on patients with bladder cancer in Ahvaz, 2023. Subjects were selected randomly from the patients those were registered in Cancer Registry Center in Ahvaz Jundishapur University of Medical sciences and invited to Golestan Hospital for data collection through clinical evaluation, the Oral Health Literacy Adult Questionnaire (OHL-AQ), and the Oral Health Impact Profile-14 (OHIP-14PER) questionnaire. The data were analyzed using Pearson correlation coefficient, independent t-test, and analysis of variance. Results: The number of participants was 194. The mean oral health literacy in patients with bladder cancer was 9.74 ± 2.39, indicating insufficient oral health literacy. A significant association was observed between OHL-AQ and DMFT index, but no significant association was found between OHIP-14PER and DMFT index. Furthermore, a significant correlation was found between OHL-AQ and OHIP-14PER (r = -0.68) in patients with bladder cancer. Conclusion: Based on the findings of the present study, all dimensions of oral health literacy have correlation with the oral health-related quality of life in patients with bladder cancer. Therefore, adopting oral health behaviors and increasing oral health literacy can be the best way to improve the oral health-related quality of life to among patients with bladder cancer.

The impact of the implementation of hierarchical medical system on population health: evidence from China.

Introduction: The implementation of a hierarchical medical system holds significant practical importance in advancing the Healthy China strategy and elevating the overall health status of the population of China. Methods: This article empirically examines the influence of the implementation of a hierarchical medical system on the health of the population using the latest 2020 China Family Panel Studies database. Furthermore, it investigates the variability of this impact across distinct health insurance participation statuses and literacy groups. Results: The findings of the study demonstrate that the implementation of the hierarchical medical system substantially enhances the health of the population, not only in terms of self-assessed health but also through a notable positive effect on alleviating chronic diseases. These results maintain their validity even after conducting robustness tests utilizing a replacement estimation model. Heterogeneity analysis reveals that the impact of the hierarchical medical system on the population's health status exhibits significant variation concerning health insurance participation and literacy. Specifically, regarding health insurance participation, the hierarchical medical system effectively improves both self-assessed health and chronic disease status among the insured population. However, for those not enrolled in health insurance, the hierarchical medical system only demonstrates improvement in chronic disease status, with insignificant results observed in enhancing self-assessed health status. Moreover, propensity score matching (PSM) was also used to address endogeneity problems resulting from sample selectivity bias. The findings demonstrate that endogeneity issues can be suitably addressed by the PSM model. Additionally, they point out that an overestimation of the impact of the hierarchical medical system on the population's self-assessed health state would result from failing to take sample selectivity bias into account. On the other hand, it will lead to the underestimation of the effect of the hierarchical medical system on the status of chronic diseases. Discussion: Moving forward, steadfast efforts should be directed toward further enhancing the implementation of the hierarchical medical system. This includes the comprehensive promotion and using the pivotal role of the hierarchical medical system in improving the health of the population.

Health literacy and mammography screening behaviors among women living in a rural area of Turkey.

INTRODUCTION: Breast cancer is the most common cause of cancer-related deaths. and early diagnosis could reduce breast cancer deaths. Therefore, health literacy is one of the most important determinants of participation in cancer screening for early diagnosis. This study aimed to determine the relationship between women's mammography screening behaviors and health literacy levels. METHODS: The cross-sectional study included 312 women aged 40-69 years living in a rural area. Data were collected through face-to-face interviews using a personal information form and the Turkish Health Literacy Scale (THLS-32). RESULTS: Of the women, 28.5% had mammography in the last 2 years. Of concern was the low health literacy levels. In addition, there were significant differences in the THLS-32 subgroup scores, including the THLS-32 total score, among the mammography screening groups. CONCLUSION: Health literacy levels of women were related to mammography screening rates. For this reason, effective intervention studies aiming to increase society's health literacy levels may contribute to an increase in breast cancer screenings.

The low health literacy in Latin America and the Caribbean: a systematic review and meta-analysis.

BACKGROUND: Health literacy (HL) impacts people's health and well-being. In Latin America and the Caribbean (LAC), there are no general estimates of the prevalence of low HL. This study aimed to estimate the prevalence of low HL among citizens of LAC and identify the tools used to measure it. METHODS: We included observational studies quantifying the prevalence of low HL in people living in LAC. We searched PubMed, CINAHL, EMBASE, ERIC, LILACS, PsycINFO, Redalyc, SciELO, Web of Science, PQDT, and the reference lists of the included studies in June 2023. Two reviewers independently conducted the selection, extraction, and risk of bias assessment using the JBI Critical Appraisal Tools. Meta-analysis of proportions using random effects models was used to summarize the prevalence of low HL estimated. This prevalence was measured in each study using different classification methods: word recognition items, reading and numeracy comprehension items, and self-reported comprehension items. RESULTS: Eighty four studies involving 23,914 participants from 15 countries were included. We identified 23 tools to assess HL, and most of the studies were carried out in health services. The pooled prevalence of low HL were 44.02% (95%CI: 36.12-52.24) for reading and numeracy comprehension items, 50.62% (95%CI: 41.82-59.39) for word recognition items, and 41.73% (95%CI: 31.76-52.43) for self-reported comprehension items. CONCLUSION: Despite the variability in the prevalence of low HL and a diversity of tools, the average of low HL is of concern. Almost half of the participants in the included studies have low HL. Most of the studies targeted users of healthcare services. Further research investigating the prevalence of low HL in the general population and actions focused on health education, communication, and information are necessary. TRIAL REGISTRATION: PROSPERO (CRD42021250286).

Traditional Chinese medicine health literacy among rural older adults: a cross-sectional study.

Background: The purpose of this study was to understand the current status of traditional Chinese medicine (TCM) health literacy among rural older adults people and its influencing factors. Methods: This study used a random number table method to select one prefecture from Henan Province, China and used a convenience sampling method to select 200 rural older adults who met the inclusion criteria in a township in northern Henan from March to April 2023. A cross-sectional survey was conducted using a general information questionnaire and a traditional Chinese medicine health literacy questionnaire, and the influencing factors of rural older adults were analyzed using univariate analysis of variance (ANOVA) and multiple linear regression. Results: The total TCM health literacy score of 200 rural older adults people was 84.14 ± 6.709. One-way ANOVA revealed that six factors, including education level, marital status, type of occupation, presence of family members engaged in medical-related work, main economic sources, and monthly income, influenced the TCM health literacy score of rural older adults people (p < 0.05). Multiple linear regression analysis revealed that education level, occupation type, and the presence of family members engaged in medical-related work were the factors influencing the TCM health literacy of rural older adults. Conclusion: The TCM health literacy level of rural older adults people is at the lower to middle level, and health educators should strengthen the publicity and education of TCM healthcare knowledge for rural older adults people to improve their TCM health literacy level and thus enhance their quality of life.

Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study.

BACKGROUND: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals' abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. OBJECTIVE: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. METHODS: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. RESULTS: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (ß=.36, P=.004), moderate to vigorous physical activity (ß=.49, P<.001), and sedentary behavior (ß=-.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. CONCLUSIONS: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere.

Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study.

Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except 'Navigating the healthcare system'. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations.

Hotspots and trends in health-oriented physical literacy research: a visual analysis based on the WOS database.

BACKGROUND: The World Health Organization has proposed that physical activity is a meaningful way to improve the quality of human life and reduce the probability of chronic non-communicable diseases and that humans should change their mindset from the actual effectiveness of physical activity in promoting health to the new view that "physical activity makes life more meaningful." The introduction and development of physical literacy reveal the critical role of physical activity in improving human health and the importance of human initiative in physical activity for healthy development. Therefore, the objectives of this paper are (1) to conduct a bibliometric analysis of the literature on physical literacy, assessing the scope, frequency, and geographical distribution of research publications from various countries and institutions from 2015 to 2023; (2) to visualize keywords in articles on the topic of Physical literacy to analyze whether there is a link between physical literacy and health, and (3) based on the results of the visual analysis, we propose that proper health is built on the sense of physical literacy and further construct the circular path of physical literacy, physical activity, and physical health improvement. METHODS: Using VOSviewer software v.1.6.18, this study searched the core collection of the Web of Science database from 2015 to April 15, 2023, using "physical literacy" as a keyword to explore the current international research on physical literacy. RESULTS: A total of 3,446 articles were included, and a correlation map was derived based on the co-occurrence frequency of keywords, which showed that physical literacy was highly correlated with six concepts: health literacy, physical activity, health, children, adolescents, and prevention. CONCLUSION: Based on the analysis of literature visualization techniques, there is a high correlation between physical literacy and health, and international physical literacy research is in a trend of multi-point amplification, with research hotspots gradually shifting from the field of sports to the field of health and closely related to the field of health, indicating that physical literacy aims to promote the achievement of individual health by driving humans to increase physical activity.

Linking Childhood Cultural Health Capital Factors with Adult Health Literacy.

Adult health outcomes are linked to childhood factors such as socioeconomic status via cultural health capital (CHC). Specifically, these factors shape opportunities for developing skills for navigating health environments via experience and the intergenerational transfer of health-related knowledge and skills. Health literacy (HL) is considered a part of and/or result of CHC. HL develops similarly to CHC via opportunities and experiences. Most research to date has ignored the effect of childhood factors on adult HL. The purpose of this study was to explore how childhood factors are related to adult HL. Data were collected from adults (N = 736, mean age = 40.65 years, standard deviation [SD] = 15.39; 52% female; 53.8% White, 31.3% Hispanic and Latino/a/e) in the United States using Qualtrics Panel. Multivariate ordinal and binary logistic regressions predicting HL (as measured by the Newest Vital Sign and Single-Item Literacy Scale) from childhood factors and accounting for demographic covariates were estimated. After accounting for covariates, such as the presence of an employed adult in a white-collar (odds ratio [OR] = 3.34) or blue-collar (OR = 3.68) occupation (versus unknown/not employed) increased the odds of being categorized as possible limited literacy and adequate literacy (versus limited literacy) as measured by the Newest Vital Sign. Similarly, having an employed adult during childhood who had a blue-collar occupation (vs. unknown/not employed) increased the odds of being categorized as adequate literacy (OR = 2.06) as measured by the Single-Item Literacy Scale. Because the adult's employment played a role in the child's adult HL after accounting for other factors and demographics, these findings support using a lifespan approach to assess and identify risk factors for lower HL. This study contributes to the growing body of evidence of how HL is interconnected with social determinants of health across the lifespan and the need to address HL skills in those with poor social determinants of health. [HLRP: Health Literacy Research and Practice. 2024;8(2):e79-e88.].

PLAIN LANGUAGE SUMMARY: Childhood conditions, such as family financial position, may be related to adult health literacy. Adults who had limited income as children were more likely to have lower health literacy than those whose family members had white-collar and blue-collar jobs. Therefore, it is important that childhood factors be considered when identifying groups that may benefit from health literacy interventions.

Compliance with COVID-19 Physical Distancing Mandates in Oman: The Role of Health Literacy and Internal Health Locus of Control.

BACKGROUND: Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions. OBJECTIVE: This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates. METHODS: A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling. KEY RESULTS: Health literacy was associated with more perceived benefits (ß = .175, p = .001), greater self-efficacy (ß = .193, p < .001), and less perceived barriers (ß = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (ß = .156, p = .007) and self-efficacy (ß = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (ß = -.276, p < .001), while injunctive norms were associated with more perceived benefits (ß = .202, p = .001) and higher self-efficacy (ß = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (ß = .427, p < .001) and perceived barriers (ß = -.205, p < .001) and benefits (ß = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions. CONCLUSIONS: This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

PLAIN LANGUAGE SUMMARY: This study examined the factors associated with Omanis' intentions to comply with physical distancing mandates during COVID-19. Results revealed that individuals with higher health literacy perceived fewer barriers and more benefits to physical distancing, making them more willing to comply with mandates. Those who believed their actions could reduce the risk of contracting the virus also reported greater benefits and were more likely to comply.

Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study.

Purpose: The aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain. Methods: This is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants' body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers. Results: In general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p < 0.001). Adolescents with lower perceived physical literacy (PPL) showed the highest estimated marginal means of body mass index, body mass index z score, waist circumference, waist-to-height ratio, and skinfold (triceps and calf) and predictive probabilities of having excess weight, obesity, and abdominal obesity, while their counterparts with high PPL had the lowest. In addition, significant differences were observed for all the obesity-related indications between adolescents with low PPL and those with medium PPL (p-adjusted < 0.05 for all indicators), as well as with those with high PPL (p-adjusted < 0.05 for all indicators). Moreover, these significant differences were also shown for most indicators between adolescents with medium PPL and those with high PPL (except for obesity). Conclusion: Physical literacy could play a crucial role in maintaining more desirable obesity-related outcomes in adolescents. Adolescents with high perceived physical literacy showed lower obesity-related indicators (i.e., body mass index, body mass index z score, waist circumference, waist-to-height ratio, skinfolds), as well as a lower probability of having excess weight, obesity, and abdominal obesity.

Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and lightGBM algorithm.

OBJECTIVE: To explore the factors affecting delayed medical decision-making in older patients with acute ischemic stroke (AIS) using logistic regression analysis and the Light Gradient Boosting Machine (LightGBM) algorithm, and compare the two predictive models. METHODS: A cross-sectional study was conducted among 309 older patients aged ≥ 60 who underwent AIS. Demographic characteristics, stroke onset characteristics, previous stroke knowledge level, health literacy, and social network were recorded. These data were separately inputted into logistic regression analysis and the LightGBM algorithm to build the predictive models for delay in medical decision-making among older patients with AIS. Five parameters of Accuracy, Recall, F1 Score, AUC and Precision were compared between the two models. RESULTS: The medical decision-making delay rate in older patients with AIS was 74.76%. The factors affecting medical decision-making delay, identified through logistic regression and LightGBM algorithm, were as follows: stroke severity, stroke recognition, previous stroke knowledge, health literacy, social network (common factors), mode of onset (logistic regression model only), and reaction from others (LightGBM algorithm only). The LightGBM model demonstrated the more superior performance, achieving the higher AUC of 0.909. CONCLUSIONS: This study used advanced LightGBM algorithm to enable early identification of delay in medical decision-making groups in the older patients with AIS. The identified influencing factors can provide critical insights for the development of early prevention and intervention strategies to reduce delay in medical decisions-making among older patients with AIS and promote patients' health. The LightGBM algorithm is the optimal model for predicting the delay in medical decision-making among older patients with AIS.

[Literacy in sexual and reproductive health as well as associated variables: multicenter study]. / Alfabetización en salud sexual y reproductiva así como variables asociadas: estudio multicéntrico.

OBJECTIVE: Limited Health Literacy implies an insufficient understanding of relevant health information, being associated with various variables. The objective of the study was to measure the prevalence of the level of Limited Sexual and Reproductive Health Literacy (AS-SR), its associated variables and the differences in scores between levels of AS-SR, universities and science of study in Chilean university students. METHODS: A multicenter and cross-sectional study, which applied a validated scale to measure levels of AS-SR, was carried out in a sample of 2,186 Chilean university students, categorizing it as high, medium high, medium low and low. The level of Limited AS-SR was obtained by adding the medium-low and low categories. Tests were carried out: descriptive, psychometric and reliability; association, logistic regression and differences between variables of interest. RESULTS: The prevalence of Limited AS-SR was 52.7%. The variables most associated with the level of Limited AS-SR were: low interest in information about health care (OR=2.819; 95% CI: 2.132-3.726), prevention (OR=2.564; 95% CI: 1.941-3.388), sexuality (OR=2.497; 95% CI: 1.807-3.452) and health promotion (OR=1.515; 95% CI: 1.239-1.853); certain sources of Information (OR=1.915; 95% CI:1.614-2.272); low economic income (OR=1.661; 95% CI: 1.361-2.026), among others. There were statistically significant differences in scores between categories of AS-SR levels, universities and study science. The scale had a reliability of 0.940. CONCLUSIONS: More than half of the students have Limited AS-SR, mainly associated with low interest in health information. The scale presents excellent psychometric indicators, being recommended for diagnoses of health situations.

OBJECTIVE: La Alfabetización en Salud Limitada implica una comprensión insuficiente de la información relevante en salud, asociándose con diversas variables. El objetivo del estudio fue medir la prevalencia del nivel de Alfabetización en Salud Sexual y Reproductiva (AS-SR) Limitada, sus variables asociadas y las diferencias de puntajes entre niveles de AS-SR, universidades y ciencia de estudio en universitarios chilenos. METHODS: Se realizó un estudio multicéntrico y transversal, que aplicó una escala validada para medir niveles de AS-SR, en una muestra de 2.186 estudiantes universitarios chilenos, categorizándola en alta, media-alta, media-baja y baja. El nivel de AS-SR Limitada se obtuvo mediante el sumatorio de categorías media-baja y baja. Se realizaron pruebas: descriptivas, psicométricas y fiabilidad; asociación, regresión logística y de diferencias entre variables de interés. RESULTS: La prevalencia de AS-SR Limitada fue del 52,7%. Las variables mayormente asociadas al nivel de AS-SR Limitada fueron: bajo interés en información sobre atención en salud (OR=2,819; IC 95%:2,132-3,726), prevención (OR=2,564; IC 95%: 1,941-3,388), sexualidad (OR=2,497; IC 95%: 1,807-3,452) y promoción de la salud (OR=1,515; IC 95%: 1,239-1,853); ciertas fuentes de Información (OR=1,915; IC 95%:1,614-2,272); bajo ingreso económico (OR=1,661; IC 95%: 1,361-2,026), entre otras. Existieron diferencias estadísticamente significativas de puntajes entre categorías de niveles de AS-SR, universidades y ciencia de estudio. La escala presentó fiabilidad de 0,940. CONCLUSIONS: Más de la mitad de los estudiantes poseen AS-SR Limitada, asociada principalmente al bajo interés en información en salud. La escala presenta excelentes indicadores psicométricos, siendo recomendable para diagnósticos de situación de salud.

Individual and family factors correlated with children's fruit consumption.

Background: Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. Methods: A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Results: Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). Conclusion: The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial.

BACKGROUND: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. OBJECTIVE: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. METHODS: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). RESULTS: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01). CONCLUSIONS: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. TRIAL REGISTRATION: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.

The relationship between health literacy and the adoption of COVID-19 preventive behaviors: A cross-sectional study in Iran.

BACKGROUND AND AIM: Health literacy (HL) is one of the effective factors in controlling the COVID-19 epidemic. Considering the high prevalence of COVID-19 disease, the present study aimed to determine the relationship between HL and the adoption of COVID-19 preventive behaviors. MATERIALS AND METHODS: This was a descriptive-cross sectional study conducted on 214 students selected by simple random sampling method in Esfarayen Faculty of Medical Sciences, Iran, in 2022. The data included demographic and background characteristics, health literacy for Iranian Adults (HELIA), and a valid and reliable questionnaire to measure COVID-19 preventive behaviors. The data were analyzed using SPSS 23, descriptive statistics, and ordinal logistic regression tests. RESULTS: The mean and standard deviation of the scores of adoption of COVID-19 preventive behaviors and HL among students were 18.18) 4.02(out of 25 and 72.14) and 12.75 (out of 100, respectively. The results of the logistic regression test showed that the HL (P = 0.003), gender (P<0.001), mother's education (P = 0.039), educational level (P = 0.031), smoking (P = 0.032), and physical activity (P = 0.007) were effective factors in adopting preventive behaviors. CONCLUSION: Adopting preventive behaviors against COVID-19 was lower among students with lower levels of health literacy, male students, students with less physical activity, students with illiterate mothers, undergraduate students, and finally smokers. Therefore, it is necessary to pay more attention to these students in designing educational programs. It is suggested to carry out more extensive studies to clarify the effect of HL on the adoption of COVID-19 preventive behaviors.

'There's no waiting list, just press play': listeners' experiences of mental-health-related podcasts.

INTRODUCTION: The activity of podcasting has increased exponentially but little is known about the qualitative listener experiences of podcasts related to mental health. The aim of this study was to understand what listeners of mental health podcasts obtain from this medium. Participants were asked questions relating to mental health literacy, stigma and help-seeking behaviour. METHODS: The study gathered data, via an online survey (n=722). This article reports on the responses to open-ended questions: 'What do you take away from listening to mental health-related podcasts? What do you learn about yourself (or a loved one)? What do you find most useful about listening to mental health-related podcasts?' Inductive thematic analysis was utilised. RESULTS: Thematic analysis produced five core themes: accessibility, mental health literacy, potential pitfalls, reassurance and lived experiences. Accessibility of material and discussions featuring professionals and people with lived experience were reported key highlights. CONCLUSION: Results indicate that podcasts influence the development of mental health literacy, reduce stigma and increase help-seeking. Given the challenges with service access in underserved populations, there is a potential role for the use of podcasts in rural regions.

The predictors of mental health literacy among adolescents students.

AIM: This study aimed to examine levels of mental health literacy (MHL) and associated factors among adolescents. METHODS: A descriptive, cross-sectional, analytical study was conducted with a total of 650 students aged 11-18 years in three middle and three high schools. Data were collected using the Child and Adolescent Mental Health Literacy Scale and evaluated using descriptive statistics and regression analysis to determine whether age, gender, and grade are predictive factors of MHL. RESULTS: The mean age of the participants in the study was 16.8 ± 1.35 years, 55 % of the students were girls, and the mean MHL score was 3.96 ± 1.2, indicating moderate MHL. Multiple regression analysis indicated that the variables of age, gender, and grade explained 5.5 % of the variance in MHL score. When these variables were examined individually, gender and grade had no significant effect (p > 0.05), while older age was associated with higher MHL score (p < 0.05). CONCLUSION: The results of this study showed that MHL improved with age. MHL promotion is important in mental health resilience. Collaboration between school nurses, school counselors, and psychiatric nurses to provide mental health educational interventions may help reduce stigma and increase help-seeking behaviors.

Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users.

BACKGROUND: As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. OBJECTIVE: This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. METHODS: The validation study was conducted in 8 PHC centers in the territory of the Macva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. RESULTS: A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P<.05) for all 7 eHLQ scores were observed for age, education, perceived material status, perceived health status, searching for health information on the internet, and occupation (except domain 4). In multivariable regression models, searching for health information on the internet and being aged younger than 65 years were associated with higher values of all domain scores except the domain feel safe and in control for variable age. CONCLUSIONS: This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of EHL and in the planning of digital health interventions at the population and individual level due to its strong psychometric properties in the Serbian context.